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Gout

By
Lynne Brown
BSc Hons, HDE, Dip Clin Nutr

Known as "the disease of kings and the king of diseases", gout has been studied by physicians and has caused suffering in countless humans since at least the days of Hippocrates. It has been called a disease of overindulgence but not everyone with gout fits the image of a beer-drinking, beef-eating, overweight middle-aged man with an exquisitely aching toe.

What is gout?

Gout is a common type of arthritis that occurs when there is too much uric acid in the blood, tissues and urine. When uric acid crystallizes it takes on the shape of needles that jab their way into the joints, causing acute pain followed by inflammation where the joints become red, swollen, hot and extremely sensitive to the touch. Gout seems to prefer the joint of the big toe but other joints in the foot, the knee and sometimes the wrist and elbow may also be involved.

What causes gout?

An excess of uric acid in the bloodstream may be caused by:

  • an increase in production by the body
  • by under-elimination of uric acid by the kidneys (poor kidney function) or
  • by increased intake of foods containing purines which are metabolized to uric acid in the body.

Foods to avoid

In most cases gout responds well to dietary changes. Certain meats, seafood, dried peas and beans are particularly high in purines. Omit anchovies, sardines, herring, haddock, shellfish, liver, kidneys and other organ meats, beef, lamb, yeast, mushrooms and gravies made with meat stock, from the diet.

In March 2004, an article was published in the New England Journal of Medicine documenting the effect of meat intake on gout risk. Harvard researchers followed almost 50,000 men for 12 years and found that "each additional daily serving of meat was associated with a 21% increase in the risk of gout." In fact, the Atkins Diet has been blamed directly for the rising incidence of this painful disease. [The Observer, 18 January 2004]

Caffeine, cauliflower, spinach and oatmeal may also be problematic for some gout sufferers.

Alcohol

Drinking alcohol causes a buildup of uric acid because it increases uric acid production at the same time that it reduces uric acid excretion. Eliminating alcohol is all that many people need to do to avoid attacks. If you do drink occasionally, stick to hard liquor or wine, both of which have fewer purines than beer.

So what can you eat?

A low-purine diet is commonly used to treat gout. Some people need to follow the diet more closely than others to prevent symptoms.

Stick to a predominantly vegetarian diet. Enjoy foods like rice, starchy vegetables, green vegetables, corn, fruit, cheese, eggs, nuts, seeds and milk.

Especially recommended are cherries. Liberal amounts (up to 500 g per day) of cherries, blueberries, strawberries and other anthocyanoside-rich (i.e. red-blue) berries should be consumed. This has been shown to be very effective in lowering uric acid levels and preventing attacks.

Drinking plenty of distilled water keeps urine dilute and promotes the excretion of uric acid. 

Peel off the pounds

If you’re overweight then reducing will lower uric acid levels but avoid crash diets as losing weight too quickly can trigger an attack. Gradual weight loss of around 500 g a week is best.

Preliminary research suggests that gout is strongly associated with the consequences of insulin resistance i.e. obesity, hypertension, high blood lipids, diabetes and dehydration. People experiencing frequent gout attacks would do well to have a fasting lipogram done as well as fasting glucose and insulin tests.

Diagnosis

Since several other kinds of arthritis can mimic a gout attack, and since treatment is specific to gout, proper diagnosis is essential. However, uric acid levels in the blood alone are often misleading and may be transiently normal or even low. Additionally uric acid levels are often elevated in individuals without gout. While sudden swelling and pain in a joint, especially the big toe, suggests the diagnosis of gout, many other arthritic conditions and some infections present themselves in a similar manner. The definitive diagnosis of gout is dependent on finding uric acid crystals in the joint fluid during an acute  attack.

Avoid aspirin

Low doses of aspirin may also be responsible for triggering a gout attack. Aspirin and aspirin-containing products should be avoided during acute attacks because they will further elevate uric acid levels.

Help from supplements

A deficiency of vitamin B5 and vitamin E can provoke an attack. A general multivitamin and mineral is recommended together with a vitamin B Complex. A supplement such as AIM’s Frame Essentials, containing MSM (methylsulfonylmethane), glucosamine, bilberry and boswellia has anti-inflammatory and pain-relieving properties. Digestive enzymes taken with meals will improve digestion of proteins.

Disclaimer: All information here is for educational purposes only and is not meant to cure, heal, diagnose nor treat. This information must not be used as a replacement for medical advice, nor can the writer take any responsibility for anyone using the information instead of consulting a healthcare professional.  All serious disease needs a physician.

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